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Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support

Patients with inflammatory bowel disease (IBD) commonly require surgery despite the availability of an increasingly large repertoire of powerful immunosuppressive medications for the treatment of IBD. Optimizing patients' care preoperatively is crucial to obtaining good surgical outcomes. This...

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Autores principales: Stoner, Patrick L., Kamel, Amir, Ayoub, Fares, Tan, Sanda, Iqbal, Atif, Glover, Sarah C., Zimmermann, Ellen M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174741/
https://www.ncbi.nlm.nih.gov/pubmed/30344603
http://dx.doi.org/10.1155/2018/7890161
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author Stoner, Patrick L.
Kamel, Amir
Ayoub, Fares
Tan, Sanda
Iqbal, Atif
Glover, Sarah C.
Zimmermann, Ellen M.
author_facet Stoner, Patrick L.
Kamel, Amir
Ayoub, Fares
Tan, Sanda
Iqbal, Atif
Glover, Sarah C.
Zimmermann, Ellen M.
author_sort Stoner, Patrick L.
collection PubMed
description Patients with inflammatory bowel disease (IBD) commonly require surgery despite the availability of an increasingly large repertoire of powerful immunosuppressive medications for the treatment of IBD. Optimizing patients' care preoperatively is crucial to obtaining good surgical outcomes. This review discusses preoperative assessment and management principles including assessing disease location and activity with cross-sectional or endoscopic imaging, addressing modifiable risk factors (i.e., stopping smoking, weaning steroids, and correcting anemia), and properly managing medications. The major focus of our literature review is the evaluation for malnutrition, a common finding that affects up to 70% of patients with IBD and a well-known, independent risk factor for adverse postoperative outcomes. Our review confirms that whenever feasible, oral or enteral nutrition (EN) is the preferred method of nutritional support; parenteral nutrition (PN) should be reserved for nutritionally deficient IBD patients unable to tolerate EN. In selected patients, recent data demonstrated that the use of preoperative PN resulted in improved nutritional status, fewer postoperative complications, and reduced disease severity. Our review highlights the need for well-designed, prospective trials investigating perioperative nutritional support in patients with IBD. Future studies should perform modern nutritional assessment, standardize for diet, and include patients with UC since this subset of patients is underrepresented in existing studies. In addition, relevant outcome of interest specific to Crohn's disease (CD) patients such as length of small bowel resected, number of anastomoses, and need for an ostomy should be included as these patients may require repeated small bowel resections.
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spelling pubmed-61747412018-10-21 Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support Stoner, Patrick L. Kamel, Amir Ayoub, Fares Tan, Sanda Iqbal, Atif Glover, Sarah C. Zimmermann, Ellen M. Gastroenterol Res Pract Review Article Patients with inflammatory bowel disease (IBD) commonly require surgery despite the availability of an increasingly large repertoire of powerful immunosuppressive medications for the treatment of IBD. Optimizing patients' care preoperatively is crucial to obtaining good surgical outcomes. This review discusses preoperative assessment and management principles including assessing disease location and activity with cross-sectional or endoscopic imaging, addressing modifiable risk factors (i.e., stopping smoking, weaning steroids, and correcting anemia), and properly managing medications. The major focus of our literature review is the evaluation for malnutrition, a common finding that affects up to 70% of patients with IBD and a well-known, independent risk factor for adverse postoperative outcomes. Our review confirms that whenever feasible, oral or enteral nutrition (EN) is the preferred method of nutritional support; parenteral nutrition (PN) should be reserved for nutritionally deficient IBD patients unable to tolerate EN. In selected patients, recent data demonstrated that the use of preoperative PN resulted in improved nutritional status, fewer postoperative complications, and reduced disease severity. Our review highlights the need for well-designed, prospective trials investigating perioperative nutritional support in patients with IBD. Future studies should perform modern nutritional assessment, standardize for diet, and include patients with UC since this subset of patients is underrepresented in existing studies. In addition, relevant outcome of interest specific to Crohn's disease (CD) patients such as length of small bowel resected, number of anastomoses, and need for an ostomy should be included as these patients may require repeated small bowel resections. Hindawi 2018-09-23 /pmc/articles/PMC6174741/ /pubmed/30344603 http://dx.doi.org/10.1155/2018/7890161 Text en Copyright © 2018 Patrick L. Stoner et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Stoner, Patrick L.
Kamel, Amir
Ayoub, Fares
Tan, Sanda
Iqbal, Atif
Glover, Sarah C.
Zimmermann, Ellen M.
Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support
title Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support
title_full Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support
title_fullStr Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support
title_full_unstemmed Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support
title_short Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support
title_sort perioperative care of patients with inflammatory bowel disease: focus on nutritional support
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174741/
https://www.ncbi.nlm.nih.gov/pubmed/30344603
http://dx.doi.org/10.1155/2018/7890161
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